Economic evaluation of a mammography-based breast cancer screening programme in Spain

The aim of the study was to perform a cost-effectiveness analysis of a breast cancer (BC) mammography screening programme, compared to a do-nothing alternative, in Spain. Screening consisted of a biennial mammography performed on ail women 50-65 years old. A marginal analysis including women 45-49 years old was also performed. With the aid of a decision tree model, the numbers of BC cases diagnosed through screening, BC cases missed by screening and false-positive BC cases were calculated. Costs were calculated by feeding local data into Markovian models and the cost-effectiveness ratio calculation was performed in a computer spread sheet. A sensitivity analysis was also conducted. Results were presented in ECUs of 1993. The cost-effectiveness ratio per avoided death is 115,500 ECUs and per saved life year 7,300 ECUs. Including women 45-49 years old in the programme raises this ratio to 229,000 and 9,400 ECUs respectively. The sensitivity analysis showed the efficacy of mammography, compliance of the programme and screening costs to be the more sensitive variables.